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CMS, the Centers for Medicare and Medicaid Services, is making a major new push to identify immigrants who are not eligible for Medicaid or the Children’s Health Insurance Program, beginning with reports this week to every state Medicaid and CHIP program regarding enrollment in these programs. The changes, announced Tuesday, include regular reports to states that will highlight enrollees with unverified citizenship or immigration status, according to senior CMS officials. The effort to target immigrants in Medicaid and CHIP, which serve 72 million and 9 million Americans, respectively, is one of the Trump administration’s most expansive actions in its second term to restrict the flow of taxpayer-funded benefits to those who are U.S. citizens or otherwise eligible to receive them.

CMS on Tuesday began transmitting monthly reports to all 50 states that will identify Medicaid and CHIP enrollees who are not eligible due to their immigration status. The reports will help states identify individuals whose citizenship or immigration status cannot be verified, using data sources such as the Social Security Administration’s systems and the Department of Homeland Security’s Systematic Alien Verification for Entitlements database. The first report this month was issued on Tuesday. Throughout the month, the remaining states will receive their reports, after which they must conduct their own review of the cases and report the results to CMS.

The CMS reports were first reported by Bloomberg and followed an earlier announcement in the same vein, and both initiatives are the result of President Donald Trump’s executive order from February of this year that prioritized immigrant eligibility for all federal benefit programs. The move this month comes as part of an ongoing Republican push to restrict immigrants’ access to public benefits, and was foreshadowed by an order from President Donald Trump in February requiring an internal review of federal benefits eligibility that same month. In March, the HHS department significantly broadened the list of benefits considered public to which the changes might apply.

“Illegal immigrants are not eligible for Medicaid, but we need to do more to enforce these restrictions,” HHS Secretary Robert F. Kennedy Jr. said in a statement. “CMS is once again taking significant steps to root out waste, fraud, and abuse, and ensure that taxpayer dollars are spent the way Congress intended.”

The new system is “the latest action CMS is taking to protect the integrity of our nation’s safety-net health programs and ensure that these programs provide benefits to only those who are eligible under the law,” CMS Administrator Dr. Mehmet Oz added in his own statement. “Every dollar spent on an ineligible individual is a dollar stolen from an eligible, vulnerable person in need of Medicaid and CHIP.”

Politico and The New York Times previously reported the CMS’s expansion of reviews of Medicaid and CHIP eligibility for immigration status. The expansion was previously rolled out except in states covered by a recent court order. In June, a federal judge ordered the Department of Health and Human Services to stop sharing enrollee information with federal immigration agencies. In a lawsuit, the department and Immigration and Customs Enforcement (ICE) had agreed to hand over certain personal information to immigration officials. The court ruled the practice went beyond what the department was legally allowed to do.

CMS officials did not indicate whether they would make the citizenship checks mandatory, although they are also moving forward with other aspects of President Trump’s executive order. States are also coming under pressure to link Medicaid eligibility to citizenship from Republicans in Washington. In spending legislation passed last month, lawmakers on Capitol Hill required states to check the eligibility of Medicaid enrollees at least twice a year. Previously, states were required to check just once.

A coalition of more than two dozen state attorneys general filed a lawsuit over the rule the same day the spending bill was passed. In their lawsuit, a group of 23 Democratic attorneys general led by New York’s Letitia James argued that the verification of immigration status would be an unfair burden that could threaten access to services for millions.

“This lawsuit seeks to stop the Administration’s unlawful implementation of this federal mandate, and to preserve the autonomy states need to continue running these life-saving programs,” James said in a statement last month. “The federal government is intent on rolling back our healthcare safety net at a time when it is needed most, while sowing fear and division in the process. This action is not just wrong; it’s unconstitutional.”